Descendent Necrotizing Mediastinitis


Authors: J. Šafránek 1;  Š. Vejvodová 1;  J. Nasswetter 2;  J. Martínek 2
Authors‘ workplace: Chirurgická klinika LF UK v Plzni a FN Plzeň 1;  Otorinolaryngologická klinika LF UK v Plzni a FN Plzeň 2
Published in: Otorinolaryng. a Foniat. /Prague/, 68, 2019, No. 1, pp. 36-40.
Category: Original Papers

Overview

Objective: Descendent necrotizing mediastinitis (DNM) results from infection in the orofacial region. A serious septic state requires an early surgical intervention.

Methods: The retrospective evaluation of a cohort of patients who underwent surgery for DNM at our workplace in 2017.

Results: The surgery of 122 paratonsillar abscesses and 9 parapharyngeal abscesses was performed at the ORL Clinic of Faculty Hospital in Plzen in 2017. The surgery for DNM concerned four patients, two women and two men of the average age of 53 years. The introductory anaerobic cultivation was always Fusobacterium and the aerobic one revealed Streptococcus anginosus in three cases. All patients initially underwent tonsillectomy and external cervical drainage. All patients subsequently needed transthoracic revision and lavage unilaterally (twice), bilaterally (twice) and repeatedly (three times). The mean duration of hospitalization was 36 days, and there was no 30-day mortality. C-reactive protein (CRP) values were in the range of 295-392 mg/l, mean 336,5 mg/l. Leukocytosis was in the range of 16.2-40.7, mean 24.8x109/l.

Conclusion: Tonsillectomy and sufficient external cervical drainage prevents the development of mediastinitis, which in the advanced stage mostly requires transthoracic approach, regular redressement and long-term intensive care.

Keywords:

descendent necrotizing mediastinitis – mediastinum drainage


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Audiology Paediatric ENT ENT (Otorhinolaryngology)
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